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Controversy.
The Media feeds on it.
Millions of patients love their chiropractor and appreciate our unique and safe approach to recovery from pain. Significant research suggests that chiropractic is the safest approach available for relief from neck pain, back pain, headaches and other “musculo–skeletal” complaints. Lets review that research, and discuss how modern medicine has contributed to the Myth that chiropractic care is dangerous. First, a short review of history
In the early 1960's, the AMA decided to try to contain and eliminate Chiropractic as a profession.
[ 1 ] The AMA's purpose was to prevent medical physicians from referring patients to Chiropractors as well as preventing them from accepting referrals from Chiropractors; to prevent Chiropractors from obtaining access to hospital diagnostic and radiology services; to prevent medical physicians from teaching at chiropractic colleges or engaging in any joint research; and to prevent any other cooperation between the two groups. The AMA also told its membership, medical students, insurance companies, and the general public that Chiropractic was an unscientific cult.
In 1976, five Chiropractors filed a lawsuit against the AMA (and other named entities) for violation of the Sherman Anti-trust Laws. After 15 years of litigation, the U.S. Court of Appeals stated that the AMA intended to “destroy a competitor,” and that there was evidence “showing that the AMA was motivated by economic concerns.” The court found that the AMA had concealed evidence showing its guilt and was caught “doctoring” documents. The AMA was also “guilty of systematic, long term wrong doing and has not acknowledged its lawlessness.” [ 1 ]
Following this reversal of AMA policy, tiny splinter groups formed with the intention of labeling chiropractic as a quackish cult. Their methods mimicked the earlier AMA suppression tactics: Create doubt about the quality of chiropractic education, and mislead the public into believing that chiropractic claims ALL disease is caused by subluxations. Although these groups hide behind the noble claim that they are protecting the public from unscientific practices, their true motives are transparent. Their sole intention is to suggest that only allopathic medicine is well supported by scientific research.
As it turns out, this is NOT the case! In an editorial in the British Medical Journal titled
Where is the Wisdom? The Poverty of Medical Evidence, BMJ editor Dr. Smith recounts a lecture he attended with renowned health policy consultant Dr. David Eddy. Eddy found, after doing significant research, that only about 15% of medical interventions are supported by, solid scientific evidence and that only 1% of the articles in medical journals are scientifically sound. Why is that? Because most of those articles reference other articles which make unfounded claims.
The Increasing Popularity of Alternative Medicine
After publication of David M. Eisenberg's 1993 New England Journal of Medicine article, various factions of modern medicine became increasingly anxious and aggressive in their accusations that alternative approaches to medical healthcare were not supported by research. [ 2 ]
This same group was NOT forthcoming in mentioning the small fraction of established medical practices that have ever met these same stringent requirements. They certainly never discussed the lower level of success that medicine has with the same health complaints that chiropractic helps so effectively.
2.2 million people have in-hospital, adverse reactions to prescribed drugs per year.
20 million unnecessary antibiotics prescribed annually for viral infections
7.5 million unnecessary medical and surgical procedures performed annually.
8.9 million people exposed to unnecessary hospitalization annually.
The most stunning statistic, however, is that the total number of deaths caused by conventional medicine is an astounding 783,936 per year. That is a mind-boggling 2147 people killed every day! That's 7 jumbo jet plane crashes, each and every day. That's a 9-11-type incident every other day... FOREVER. God help us all.
This comprehensive study reviewed all the published literature on low back pain and made some astounding suggestions. In a nutshell, it concluded that chiropractic should be the treatment of choice for low back pain–to the exclusion of traditional medical care.
The specific findings of the report were:
There is an overwhelming body of evidence indicating that chiropractic management of low-back pain is more cost-effective than medical management
Many medical therapies are of questionable validity or are clearly inadequate
There is no clinical or case-control study that demonstrates or even implies that chiropractic spinal manipulation is unsafe in the treatment of low-back pain. Some medical treatments are equally safe, but others are unsafe and generate iatrogenic complications for LBP patients.
Chiropractic is more cost-effective.
There would be highly significant cost savings if more management of LBP was transferred from medical physicians to chiropractors.
There is good empirical evidence that patients are very satisfied with chiropractic management of LBP and considerably less satisfied with physician management
The Recommendations were:
Chiropractic services should be fully insured under the Ontario Health Insurance Plan
Chiropractic services should be fully integrated into the health care system. Because of the high incidence and cost of LBP, hospitals, managed health care groups, community health centers, comprehensive health organizations, and health service organizations and long-term care facilities should employ chiropractors on a full-time and/or part-time basis
A good case could be made for placing chiropractic as the gatekeepers for all musculoskeletal complaints that presented to hospitals.
A series of articles reporting on the lack of medical training in musculoskeletal disorders was published between 1998 and 2002 by Kevin B. Freedman, MD [ 7 ], [ 8 ]. It seems that the department chairs of several hospital-based orthopedic residency programs designed a basic examination on musculoskeletal competency and gave it to their residents. 82 per cent of medical school graduates failed the examination. Four years later the test was simplified and, once again, 78% of the examinees failed to demonstrate basic competency in musculoskeletal medicine.When this test was given to final quarter chiropractic students 70% of them passed the same exam! [ 9 ]
The differences between these 2 student groups should be noted. The medical students had already graduated from medical school (as MDs) and had currently been deployed in rotation through various hospital departments. They had also been accepted into an orthopedic residency program...as the pinnacle of medical musculoskeletal specialists. The chiropractic students however were still just students.
80% medical failure versus 70% chiropractic success. Quite astonishing!
Other reports listing a higher frequency of adverse events have been compromised by the tendency of those authors to inappropriately list the pracitioner as a chiropractor, even when it turned out that the injury was caused by a medical doctor, a physical therapist or perhaps a hairdresser! [ 11 ], [ 12 ]
Rather than raising concerns about the safety of chiropractic, this clarifies the fact that spinal manipulation, in the hands of unskilled practitioners, must be halted and closely regulated.
[ 13 ]
The World Health Organization recently released a comprehensive set of guidelines that clearly states that chiropractic is a separate profession, rather than a set of techniques that can be learned in short courses by other health professionals. They also make it clear that medical doctors and other health professionals, in countries where the practice of chiropractic is not regulated by law, should undergo extensive training to re-qualify as chiropractors before claiming to offer chiropractic services. In some countries there have been recent efforts by medical groups to provide short courses of approximately 200 hours in chiropractic technique. WHO’s guidelines indicate that a medical graduate should a require an additional minimum of 1800 class hours, including 1000 hours of supervised clinical training, before claiming to offer chiropractic services.
[ 14 ]
B. The Safety of Low Back Adjusting
Lower back injury alleged to have occurred following spinal manipulative therapy has been reported in patients with pre-existing disc herniation or prolapse. While it is suggested that the forces required to cause a disruption of the annular fibers of the healthy intervertebral disc well exceed that of a rotational manipulative thrust, some disc herniation/protrusion may certainly be aggravated by an inappropriately applied manipulative maneuver, as it may be by other simple activities of daily living such as bending, sneezing, or lifting. The most frequently described severe complication is compression of the cauda equina by massive midline nuclear herniation at the level of the 3rd, 4th or 5th intervertebral disc.
Of the 30 cauda equina complications associated with manipulation reported in the French, German and English literature over an 80 year period, only 8 were allegedly related to chiropractic treatment.
[ 15 ]
The Risks of Medical Procedures Aimed at Relief of Similar Symptoms
Another article titled “36 Percent of Acute Liver Failures Are Linked to Acetaminophen” suggests that other organ systems are also compromised by the use of over-the-counter pain medications.
[ 17 ]
Lauretti's review of the literature found that The best evidence indicates that cervical manipulation for neck pain is much safer than the use of NSAIDs, by as much as a factor of several hundred times. [ 27 ]
With the total number of lower back surgeries having been estimated in 1995 to exceed 250,000 in the U.S. at a hospital cost of $11,000 per patient. [ 19 ] This would mean that the total number of unnecessary back surgeries each year in the U.S. could approach 44,000, costing as much as $484 million.
[ 20 ]
So, the biggest risk of spinal surgery is that it may not be necessary.
The next set of risks include:
a 2.1% chance of a serious adverse drug reaction.
[ 21 ]
a 5-6% chance of acquiring a nosocomial infection [ 22 ]
a 4-36% chance of having an iatrogenic injury (medical error or adverse drug reactions).
[ 23 ]
As few as 5%, and no more than 20% of iatrogenic injuries are ever reported! Yipes! [ 5 ]
That takes all the fun out of being a statistic, doesn't it?
This September 2006 article from the Journal of the American Academy of Orthopedic Surgeons says it all:
“Failed back surgery syndrome is a common problem with enormous costs to patients, insurers, and society. The etiology of failed back surgery can be poor patient selection, incorrect diagnosis, suboptimal selection of surgery, poor technique, failure to achieve surgical goals, and/or recurrent pathology.”
[ 25 ]
That my friends is right from the horse's mouth.
The most recent controversy is from the New York Times:
“Spinal-fusion surgery is one of the most lucrative areas of medicine. An estimated half-million Americans had the operation this year, generating billions of dollars for hospitals and doctors.
But there have been serious questions about how much the surgery actually helps patients with back pain and whether surgeons’ generous fees might motivate them to overuse the procedure. Those concerns are now heightened by a growing trend among some surgeons to profit in yet another way — by investing in companies that make screws and other hardware they install.” [ 26 ]
Now, on top of all the other concerns about medicine's poor training and dangerous statistics, we have to wonder if the orthopedist is motivated to use those 6—$1000 screws on your spine because they are a stockholder of that lucrative medical device manufacturer. God help us!
The sanest and safest approach is to use conservative approaches like chiropractic care first. You can always resort to medicine as a last-ditch resort, but statistics suggest that most low-back and neck pain can be successfully managed with lower costs and higher patient satisfaction by chiropractors.
